Fear of codes? Seminar by Kathy Forbes prepares the hygienist for using the correct insurance codes
By Ann-Marie DePalma, RDH, MEd, FADIA, FAADH
C-D-T. Those three letters that can evoke fear and frustration in the hearts of many a dental professional. The Current Dental Terminology or "codes" are the lifeblood of any dental practice. But do hygienists really understand the codes they're using, or does patient insurance dictate what the hygiene team performs?
Kathy S. Forbes, RDH, BS, has developed a program, "Treating, Reporting, and Managing Periodontal Diseases: A Dental Hygienist's Perspective." Her program delves into the complex world of treatment-planning periodontal disease, and the appropriate treatment codes to select while helping hygienists understand the definitions.
Kathy's program:
- Discusses what dental "insurance" is and what it is not, including fee-for-service vs. PPO plans and plan limitations
- Reviews the dental hygiene diagnosis and the AAP Classifications/case types
- Explains informed consent and informed refusal
- Examines the CDT codes specific to dental hygiene while reviewing the most current CDT definitions
- Discusses treatment planning and selecting the appropriate codes
- Discusses the impact the new diagnostic codes may have on dental claims submissions
- Examines dental insurance fraud and its prevention
Kathy also provides motivation and education regarding the business side of dental hygiene practice by discussing what constitutes a business with overhead and how hygiene salaries play a role in a practice's profit or loss. She examines the role marketing trends play and how one can become an impact employee from day one.
Practices are seeing an ever growing number of patients' benefits shrinking, especially in the preventive and basic categories of coverage. Kathy provides participants with the verbiage necessary to educate patients about benefit plan limitations and cost containment measures, while enlightening them about oral disease vs. health.
Through a sense of confusion and wanting to please patients, many dental practices unwittingly perform insurance fraud, which is often prompted by the insurance companies themselves. Unfortunately, ignorance, or "they told me to change the code," is not bliss. Neither are good defensive measures if the case is ever brought to a grand jury. Hygienists want to provide the best possible care to patients but dental hygiene education doesn't adequately inform them of the appropriate use of the CDT codes. Once in practice, hygienists count on the business team "to handle things," often without fully understanding the implications.
Kathy's goal is to help hygienists pull their heads out of the sand and become collaborative partners with the business team in achieving the best for their patients and practice. Understanding the entire coding process can lead to increased revenue for the practice. Hygienists can also be instrumental in providing increased revenue by working with the business team to submit some dental and dental hygiene procedures through patients' medical insurance plans.
Kathy is a graduate of the Clark Community College Dental Hygiene program in Vancouver, Washington, and received her bachelor's in occupational education from Southern Illinois University. After practicing for several years, she taught in two different dental hygiene programs for 12 years.
When she moved from Washington to California, different opportunities presented themselves, and she found herself back in clinical hygiene for several different practices. Within a short time, she learned that the offices wanted her to document procedure codes for the types of procedures she performed. This was the first time she learned about a code book, and she'd been teaching dental hygiene for years! In one practice, the owner had recently passed away and the practice had hired a new dentist to keep the practice functioning. The previous hygienist had also left and thus Kathy was hired. From the first day she discovered patients without radiographs or updated perio charting, and that everyone had been treated as a prophy patient.
She discussed her concerns with the new dentist and he told her to take care of it and treat the patients accordingly. She formed a bond with a business team member and worked collaboratively with her and with patients to educate them about their situations and their reimbursement benefits. Thus, her knowledge of coding was born.
When she moved back to Washington, she began working as a temporary hygienist in a variety of practices, where she documented not only the treatments she performed but the appropriate CDT codes to support them. In every case, the business team members wanted her to teach their hygienists about the correct coding processes. This led to the establishment of her company, Professional Dental Seminars, Inc., which provides continuing education for teams about submitting the correct codes and mitigating risk management. She also presents a program for dental hygiene students called "The Practical Side of Dental Hygiene Practice," which provides them with practical approaches to dental hygiene treatment planning of periodontal disease in the world beyond hygiene school.
Kathy provides participants with extensive handouts that contain pertinent PowerPoint slides, articles, useful charts, and forms that can be used in paper-based practices or formatted for dental software programs. She loves to roam the room and has been told she has a good sense of humor. She accentuates her program by sharing vulnerable moments from her own career and by sharing patients' stories as well.
Kathy loves to spend time with her family, and always tries to find time to spend with her husband despite their hectic schedules. Her son is a personal trainer in California. Professionally, Kathy enjoys letting her fellow hygienists know that there is more to do than "scrape roots in an 8x10 room every day." Hygienists need to be proactive in adding value to their practices while standing up for patients and providing the quality care that patients deserve. She's been a member of ADHA since early in her career, and she's concerned that the grassroots hygienists' needs and day-to-day concerns are not being met.
Kathy chose dental hygiene because what she wanted in the early 1970s was to go to school in the shortest amount of time and make the most money in a career that required people skills and good hand-eye coordination. She considered nursing but didn't want to deal with the four-year program. She enjoys seeing former students who comment that she was tough but fair, and she rejoices in how they have succeeded in their careers. As a clinical hygienist, professor, speaker, author, mentor, coach, and volunteer, Kathy is grateful for all of the opportunities that dental hygiene has afforded her, and she wouldn't change a thing about her career choice.
She enjoys answering participants' questions, sharing experiences and supporting fellow hygienists, but she doesn't like participants who have their own agenda or try to sway the agenda of the program. Kathy writes for "Insurance Solutions Newsletter" published by Dr. Charles Blair and Associates, where she answers frequently asked questions regarding treatment planning, procedure code selection, and insurance benefits.
In 2010 she was honored by the Washington State Dental Hygienists' Association with the Martha Fales Award for Lifetime Achievement for her selfless, passionate, and international dedication to the profession.
Understanding the appropriate CDT codes to increase production and provide the best care for patients is Kathy's mission. Join her to elevate your knowledge so that you can successfully share that knowledge with your patients. For more information about Kathy or her programs, contact [email protected] or call (253) 670-3704.
Thought for the month:"You have to learn the rules of the game. And then you have to play better than anyone else." -Albert Einstein RDH
ANN-MARIE C. DEPALMA, RDH, MEd, FADIA, FAADH, is a Fellow of the American Academy of Dental Hygiene and the Association of Dental Implant Auxiliaries, as well as a continuous member of ADHA. She presents continuing education programs for dental team members on a variety of topics. Ann-Marie is collaborating with several authors on various books for dental hygiene and can be reached at [email protected].
